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General NPI Number Information
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NPI Number | 1770509770
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Entity Type | Organization
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Legal Business Name | BOURBON HEIGHTS INC
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 07/10/2008
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Provider Practice Location Address
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Address Line | 2000 MAIN ST
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City | PARIS
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State | KY
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Zip | 40361-1149
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Country | US
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Telephone | 859-987-0065
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Fax | 859-987-6460
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Provider Business Mailing Address
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Address Line | 2000 MAIN ST
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City | PARIS
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State | KY
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Zip | 40361-1149
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Country | US
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Telephone | 859-987-5750
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Fax | 859-987-6460
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Authorized Official
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Title or Position | BUSINESS OFFICE MANAGER
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Name | MRS. CHARLOTTE LEE ROBERTS
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Credential |
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Telephone | 859-987-5750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 750139
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License Number State | KY
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